How should depression be diagnosed in patients with stroke?

Spalletta, Gianfranco; Robinson, Robert G.

doi:10.1111/j.1600-0447.2010.01569.x

Cited by 22 publications

(13 citation statements)

References 27 publications

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“…According to Spalletta and Robinson [44], except for the relative absence of guilt, the symptoms of depressive disorders in stroke patients are quite similar to those of MD diagnosed in patients without clinical comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Is Poststroke Depression a Major Depression?

Silva

Brasil²,

Nascimento³

et al. 2013

Cerebrovasc Dis

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Background: Poststroke depression (PSD) is the most common neuropsychiatric consequence of stroke. A large number of studies have focused on the pathogenesis of PSD, but only a few aimed to characterize its psychopathology; these studies yielded results that are difficult to compare because of the different methods utilized. The current study aimed to characterize the symptom profile of PSD in an attempt to better understand the disease and allow a more accurate diagnosis. Methods: The study sample comprised 64 patients divided into three groups: stroke patients without diagnosis of depression (n = 33), stroke patients diagnosed with PSD (PSD group, n = 14) and patients diagnosed with major depression (MD) but with no clinical comorbidity (MD group, n = 17). All patients were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The initial diagnostic interview was complemented by the Mini Mental State Examination (MMSE), the Rankin Scale, and four scales for the assessment of the intensity of symptoms of anxiety and depression: the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression General Scale (HADS), the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). The Star Plot, a graphical method of data visualization, was used to analyze the results. The t test was used for independent samples (two-tailed analysis). Results: As measured by the BDI, HAM-D and HAM-A scales and HADS depression subscale, the average total scores of symptoms for the sample of patients diagnosed with MD without clinical comorbidity was significantly higher than that of the PSD patients (p < 0.05). Similar results were obtained by plotting the BDI data on Star Plot. The PSD patients showed mild typical depressive symptoms such as less depressed mood, anhedonia, disinterest, guilt, negative thoughts, depreciation, suicidal ideation and anxiety, when evaluated by the HAM-A scale. Moreover, the somatic symptoms of depression did not lead to increased diagnosis of major depression in stroke patients. Conclusions: The results indicate that the PSD clinical picture comprised, in general, symptoms of mild/moderate intensity, especially those considered as pillars for the diagnosis of depression: depressed mood, loss of pleasure and lack of interest. Given the imprecision of boundaries that separate the clinical forms of depression from subclinical and nonpathological forms, or even from the concepts of demoralization and adjustment disorders, we situate PSD in a complex biopsychosocial context in which a better understanding of its psychopathological profile could provide diagnostic and therapeutic alternatives best suited to the difficult reality experienced by stroke patients.

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Section: Discussionmentioning

confidence: 99%

Is Poststroke Depression a Major Depression?

Silva

Brasil²,

Nascimento³

et al. 2013

Cerebrovasc Dis

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“…Although PSDD was widely accepted and defined in MDD criteria of DSM-IV,22 this viewpoint was argued by some investigators 23,24. In order to avoid neglecting the depressive stroke survivors down to the diagnostic criteria of MDD, Robinson et al25 suggested dividing depression into major and minor types according to different criteria in the 1980s.…”

Section: Discussionmentioning

confidence: 99%

New opinion on the subtypes of poststroke depression in Chinese stroke survivors

Yue

Chen

et al. 2017

NDT

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AimPoststroke depression (PSD) is the most common complication of stroke. However, some stroke survivors with depression cannot meet the diagnostic criteria of PSD. The aim of this study was to propose the new conception of stroke patients with depression and then make them to receive reasonable diagnosis and treatment.MethodsWe first put forward the opinion that the general PSD should consist of PSD disorder (PSDD) and PSD symptoms (PSDS) according to the Diagnostic and Statistical Manual of Mental Disorder – Fifth Edition (DSM-5) and ZhongDa diagnostic criteria – first edition (ZD-1), respectively. The ZD-1 was established based on the suggestions of 65 Chinese chief doctors considering that the symptoms of PSDS might be different from those of PSDD and the duration of DSM-5 was too strict. Then, 166 stroke inpatients were recruited, and the study was conducted using the diagnosis and classification of PSD to verify the new concept.ResultsA total of 24 (14.46%) and 80 (48.19%) stroke patients were diagnosed with PSDD and PSDS, respectively, according to individual diagnosis criteria. Moreover, patients meeting the diagnostic criteria of PSDD should satisfy the criteria of PSDS first. The distribution frequencies of depressive symptoms were different, which suggested that there might be discrepant depressive symptoms between PSDS and PSDD.ConclusionThe present study proposes new opinion about the classification and diagnosis of depression in stroke survivors. The definition and criteria of PSDS are beneficial to explore phenomenological consistency and provide useful information for early recognition and appropriate interventions.

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“…According to Spalletta and Robinson 18 , although it seems likely that some forms of PSD may be, in part, sustained by reaction to disability, the attempt to differentiate between "reactive" (i.e. demoralization) and "endogenous" forms of depression ceased many years ago because no clear etiopathogenetic or phenomenological distinction has ever been shown to distinguish between them and a mixture of these two forms is present in almost all patients with a diagnosis of depression.…”

Section: Diagnosis and Clinical Picturementioning

confidence: 99%

“…Despite these controversies, there is no evidence that the diagnosis of depression after stroke is less valid than the diagnosis of depression in non-stroke populations 18,20 . Since there are no specific biological markers, the diagnosis is based on clinical findings, and this task can become very difficult in the presence of severe cognitive deficits, especially language disorders.…”

Section: Diagnosis and Clinical Picturementioning

confidence: 99%

Post stroke depression: clinics, etiopathogenesis and therapeutics

Pedroso¹,

Souza²,

Brunoni³

et al. 2015

Arch. Clin. Psychiatry (São Saulo)

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Background: Stroke is a major cause of morbidity and mortality worldwide. Neuropsychiatric disorders are often associated with stroke and, among them, depression is the most prevalent. Post-stroke Depression (PSD) is related to disability, failure in returning to work, impairment in interpersonal functioning and mortality. Its etiopathogenesis is still uncertain, as well as its treatment. In Brazil, there are few data on the impact of PSD. Objective: This work is dedicated to conduct a comprehensive review of the concept of PSD, its pathophysiology, morbidity and treatment. Methods: PubMed, Medline and Lilacs searches of relevant terms yielded 3,265 papers in the last 10 years. We selected original studies and reviews that addressed the aspects mentioned above. Results: We present the history of the notion of PSD and describe its epidemiology, looking to highlight Brazilian studies. Diagnostic criteria and clinical presentation were detailed, with emphasis on cognitive aspects. The four main pathophysiological theories proposed to PSD are presented and we discuss the various treatment strategies, involving psychopharmacologic options, brain stimulation techniques and psychotherapy. Discussion: This work provides comprehensive information on PSD, of great utility for clinical practice and research in this topic.

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How should depression be diagnosed in patients with stroke?

Cited by 22 publications

References 27 publications

Is Poststroke Depression a Major Depression?

Is Poststroke Depression a Major Depression?

New opinion on the subtypes of poststroke depression in Chinese stroke survivors

Post stroke depression: clinics, etiopathogenesis and therapeutics

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